Since the Centers for Medicare & Medicaid Services introduced the hospital Outpatient Prospective Payment System in 2002, industry has not typically looked forward to the coming year's iteration of the agency's system for reimbursing drugs in the hospital outpatient setting. The same has been true for CMS's Physician Fee Schedule (Part B) program to reimburse drugs administered in the physician setting. But this year CMS appears to have heeded many of industry's concerns related to inconsistent payment methodologies that companies said do not reflect the true cost of drugs.
Indeed, based on public comment from industry, physician and hospital groups, and patient advocacy groups, this year's final rules reflect changes in many details CMS had proposed in August. In general, the agency appears to have tried to align its payment methodologies for both programs based on an average sales price (ASP) plus 6% methodology as mandated by the Medicare Prescription